Here we present our technique of aortic valve replacement through a reversed C-shaped ministernotomy in 36 patients operated between 2017 and 2019. All patients had a preoperative computed tomography that guided the surgical approach. The sternum was incised at the level of the first and third or the second and fourth intercostal spaces. Cross-clamp time was of 65.2 ± 15.9 minutes. Median extubation time was of 2 hours. There was no postoperative 30-day mortality. Because the upper and lower parts of the sternum remain intact, this approach may improve postoperative thoracic stability.Hyponatremia is an unrecognized risk factor for adverse outcomes after cardiac surgery. We sought to study the prevalence of preoperative hyponatremia and its impact in short-term and long-term outcomes after cardiac surgery.
Patients who had CABG, valve, or CABG and valve procedures from 2000 to 2016 and available preoperative serum sodium within 30 days of the index procedure were included in the study. The effect of preoperative sodium on short and long-term outcomes was analyzed as a continuous and as a binary (hyponatremia (Na+&lt;135mEq/L) vs. no hyponatremia) predictor variable in multivariable regression models.
Preoperative hyponatremia was present in 9.9% of 16,238 patients with available sodium levels. https://www.selleckchem.com/products/sodium-bicarbonate.html Comorbidities were more common in patients with hyponatremia. Hyponatremia was independently associated with operative mortality (OR 1.80, 95% CI 1.38 - 2.34, p&lt;0.001), long term mortality (HR 1.31, 95% CI 1.21 - 1.40, p&lt;0.001), longer post-operative length of stay (HR 1.35, 95% CI 1.28 - 1.43, p&lt;0.001), renal failure (OR 1.52, 95% CI 1.20- 1.93, p&lt;0.001), prolonged ventilation (OR 1.52, 95% CI 1.30 - 1.78, p&lt;0.001), and stroke or TIA (OR 1.48, 95% CI 1.09 - 2.02, p=0.013). Severity of hyponatremia, as measured by sodium level, was similarly associated with increased risk of death and post-operative complications.
Preoperative hyponatremia is relatively common and is associated with adverse short- and long-term outcomes after cardiac surgery. Preoperative hyponatremia can be used independently from standard risk factors to identify high risk patients for cardiac surgery.
Preoperative hyponatremia is relatively common and is associated with adverse short- and long-term outcomes after cardiac surgery. Preoperative hyponatremia can be used independently from standard risk factors to identify high risk patients for cardiac surgery.Previous studies suggest that birth prior to 39 weeks gestational age (GA) is associated with higher perioperative mortality and morbidity after congenital heart surgery. The optimal approach to timing of surgery in premature infants remains unclear. We investigated the impact of GA at birth and corrected GA at surgery on post-operative outcomes using the Pediatric Cardiac Critical Care Consortium (PC) database.
Infants undergoing selected index cardiac operations before the end of the neonatal period were included (n=2,298). GA at birth and corrected GA at the time of index cardiac surgery were used as categorical predictors and fitted as a cubic spline to assess non-linear relationships. The primary outcome was hospital mortality. Multivariable logistic regression models assessed the association between predictors and outcomes while adjusting for confounders.
Late-preterm birth (34-36 weeks) was associated with increased odds of mortality compared to full-term (39-40 weeks) birth while early-term birth (37-38 weeks) was not associated with increased mortality. Corrected GA at surgery of 34-37 weeks compared to 40-44 weeks was associated with increased mortality. When analyzing corrected GA at surgery as a continuous predictor of outcome, odds of survival improve as patients approach 39 weeks corrected GA.
Contrary to previous literature, we did not find an association between early-term birth and hospital mortality at PChospitals. Our analysis of the relationship between corrected GA and mortality suggests that operating closer to full-term corrected GA may improve survival.
Contrary to previous literature, we did not find an association between early-term birth and hospital mortality at PC4 hospitals. Our analysis of the relationship between corrected GA and mortality suggests that operating closer to full-term corrected GA may improve survival.Reconstruction of the anterior chest wall defect after sternectomy is a challenge for cardiothoracic surgeons. In 2010 the Padua group published the first case of cadaveric sternum transplantation after sternectomy. This multi-center study reports the clinical indications, early and long-term results of sternal chondral allograft transplantation.
This is a retrospective multicentre-study from seven Academic-Centres. Demographic data, surgical indications, technical details, early postoperative results were collected. The complications, long-term stability and tolerance of the allografts were also analysed.
Between January 2008 and December 2019 58-patients underwent sternectomy followed by reconstruction using cadaveric-cryopreserved sterno-chondral allografts. Thirty-two patients were males, with a median age of 63.5 years(IQR50-72). Indications for sternectomy were secondary sternal tumors(n=13), primary sternal tumors(n=15) and non-neoplastic disease(30). Thirty patients underwent total sternectomy, ent of the sternum. The collected results demonstrate that sterno-chondral allograft transplantation is a safe and effective method in reconstructing the anterior chest wall after sternectomy. Further studies to demonstrate the integration of the bone grafts into the patient's sternal wall will be made.Surgical transpleural minimally invasive occlusion of perimembranous and muscular ventral septal defects (VSDs) provides excellent results, but with limited experience in outlet VSD (OVSD) because of the specific anatomy and because OVSD may occur with aortic valve prolapse.
The procedure was performed in 84 children (mean age 2.5±2.3 years; mean weight 12.1±10.3 kg) between July 2014 and December 2018 at the Children's Heart Center of Henan Provincial People´s Hospital. An approximately 2-cm right subaxillary incision was made, and the right ventricle was punctured under transesophageal echocardiographic (TEE) guidance. The OVSD was occluded under TEE guidance with an asymmetric occluder.
The mean size of the OVSDs and the occluders was 4.6±1.0 mm and 6.2±1.2 mm, respectively. No patients died and no complications occurred, such as third-degree atrioventricular block, new aortic regurgitation, reoperation, and serious infection. All patients were followed for 32.1±17.1 months. Postoperatively, there were four cases of residual shunt, which resolved spontaneously during follow-up.